Subthreshold stimulation at the focal origin of para-Hisian-located ectopic atrial tachycardia

The focal origin of ectopic atrial tachycardia (EAT) is occasionally located in the superoparaseptal region adjacent to the bundle of HIS. Radiofrequency catheter ablation (RFCA) of EAT in this anatomic location implies the potential hazard of adverse impairment of the AV conduction. Therefore, careful precise mapping is mandatory. Subthreshold stimulation as defined as the delivery of noncaptured low energy pulses has been introduced as an additional mapping technique for slow pathway ablation in the setting of AV nodal reentrant tachycardia and other reentrant tachycardia. A patient with a right superoparaseptal EAT focus, in which subthreshold stimulation (STS) could determine the site of successful subsequent RFCA is described. During STS with EAT termination no AV conduction disturbances, junction-escape rhythms or atrial capture could be recorded. Thus STS may be used as an additional mapping tool to identify successful ablation sites in EAT.